**BLOOMS MILL POOL SUMMER 2010 BIG

FISH **
1. Please fill out one registration form per child.
2. Payment for classes is due at time of registration.
3. To register online: please visit www.guardianswimacademy.com; click on
registration form and complete. You will then be directed to the online store
which will allow you to purchase your classes.
4. You may pay with cash or check in person at the pool. Or you may pay with
VISA, MASTERCARD, AMEX, DISCOVER or BANK DEBIT on our website.
5. Please call 571.315.3475 or 703.368.6639 if you have any questions
regarding classes, sessions or to make payment arrangements.

CHILD’S INFORMATION
First Name/MI/Last Name: _________________________________________________

Age: ________________ Date of Birth: _____/_____/_____

Please Circle: Male Female

SELECT PROGRAM See guardianswimacademy.com or call 571.315.3475 or

703.368.6639
SIBLING DISCOUNT: For more than one swimmer in a family; the first child is the regular price
and additional siblings receive $25.00 off.
This discount is available for the lower priced sibling(s).

Buy 2 or more sessions and get FREE STUFF!!!!

2 sessions – FREE GOGGLES!!
3 sessions – FREE GOGGLES and SWIM TOWEL!!
4 sessions – FREE GOGGLES, TOWEL and WATER BOTTLE!!
5 sessions – FREE GOGGLES, TOWEL, BOTTLE and SWIM BAG!!
6 sessions – FREE GOGGLES, TOWEL, BOTTLE, BAG and GSA HOODIE!!
(sessions must be paid for in full or payment plan set to recieve free items)

BLOOMS MILL POOL

Classes are on Monday, Wednesday, Thursday and Friday for 45 minutes
each.

BIG FISH (2 week sessions) - $125.00

_____ Session 1 (June 7-June 18) _____ Session 2 (June 21-July 2)
_____ Session 3 (July 6-July 16) _____ Session 4 (July 19-July 30)
_____ Session 5 (Aug 2-Aug 13) _____ Session 6 (Aug 16-Aug 27)
TIME (please check one): _____4:00PM _____5:00PM _____6:00PM _____7:00PM

BIG FISH (1 week sessions) - $75.00

_____ Session 1A (June 7-June 11) _____ Session 1B (June 14-18)
_____ Session 2A (June 21-June 25) _____ Session 2B (June 28-July 2)
_____ Session 3A (July 6-July 10) _____ Session 3B (July 12-July 16)
_____ Session 4A (July 19-July 23) _____ Session 4B (July 26-July 30)
_____ Session 5A (Aug 2-Aug 6) _____ Session 5B (Aug 9-Aug 13)
_____ Session 6A (Aug 16-Aug 20) _____ Session 6B (Aug 23-Aug 27)
TIME (please check one): _____4:00PM _____5:00PM _____6:00PM _____7:00PM
_____ Upgrade any session to a private class (add additional $100)
_____ Upgrade any session to a semi-private class (add additional $50)
TOTAL SUMMER SESSION $________
MEDICAL INFORMATION
Please list any special needs, concerns or medical conditions:
____________________________________________
Insurance Company/Policy Number:
________________________________________________________________
Policy Holder’s Name:
____________________________________________________________________________

PAYMENT METHOD (Circle One): TOTAL

ENCLOSED: $__________
Check Cash

PARENT INFORMATION
Parent(s)/Guardian(s) Name:
_____________________________________________________________________
Address:
_____________________________________________________________________________________
City, State, Zip:
________________________________________________________________________________
Home Phone Number: ______________________________Cell Phone Number:
___________________________
Business Phone Number: _______________________________ E-mail:
_________________________________

GUARDIAN SWIM ACADEMY POLICIES AND PROCEDURES (Please

read and SIGN BELOW)
Lessons Attendance
We have a very short season and each lesson will progressively build on the
previous, so please plan on attending all
lessons in the session. If you must miss a lesson please contact GSA
(571.315.3475) as soon as possible.
Make-Up Policy
Make-ups for group lessons will be scheduled for weather closings and for illness
(proof from doctor needed) ONLY.
Because we schedule make-ups based on available spaces, times are not
guaranteed and will be scheduled based on
space available in the current session. Due to space limitations, we are unable to
offer private/semi-private make-ups,
but private and semi-private lessons client may do a group make-up as detailed
above. Some make-ups may be
schedule during the weekend please contact GSA if you would like to make-up a
lesson.
Refund/Withdrawal Policy
Once a session has started there are NO REFUNDS. We hire instructors and rent the
facility based on registration. If
you have signed up for a session and decide to withdrawal you must notify GSA at
least 1 (one) week prior to the
session start date in order to receive a refund. NO REFUND will be issued if you
withdrawal from classes less
than one week prior to the start of the session.
Weather Policy
Although there may be thunderstorms at your house, the weather may be fine at the
pool. Check the GSA website to
see if lessons have been cancelled. Weather is very unpredictable and lessons may
be stopped 5 minutes after it
starts. Please prepare a plan with your swimmer in case the pool must close before
the end of practice. You can also
get up to the minute updates with twitter: www.twitter.com/guardianswim

Parent/Guardian Name (please print):

_____________________________________________________________
Parent/Guardian Signature: _________________________________________________
Date: _______________